MUMBAI: When a corporate executive recently landed in the emergency ward of Hiranandani Hospital in Powai with palpitations, doctors first checked his heart. When tests ruled out any cardiac problem, they found an unlikely culprit—too many cups of green tea. “After talking to him, we realized he had had over a dozen cups of green tea within the span of a few hours,” said cardiologist Ganesh Kumar.

Some brands of green tea contain caffeine, an agent that boosts heart rate. “Green tea is supposed to be a natural agent to control blood pressure, weight, etc, but everything has to be consumed in the right measure,” Dr Kumar said.

As the natural or herbal revolution gains in popularity, doctors believe it’s time to sound a health warning, especially to patients already on various allopathic medications. Studies have shown that seemingly harmless suppleme nts can have dangerous side-effects when consumed in excess.

Garlic is a natural way to keep BP in check, but it may not always be good for those taking blood-thinning pills.

Similarly, using fenugreek seeds in your food is the natural and easiest way to control the release of sugar (from your food) into the bloodstream. But, as nutritionist Shilpa Joshi has found among diabetic patients, the tendency is to be liberal in using the methi seeds. “Some add so much of fenugreek to their food that their blood sugar drops all of a sudden to alarming levels,” she said.

The latest edition of ‘Alternative and Complementary Therapies‘ has pharmacist Catherine Ulbricht from Massachusetts General Hospital spelling out the potential dangers of mixing herbal supplements and therapeutic agents; their interaction can diminish or increase drug levels. “‘Natural’ does not equal ‘safe,'” she said in the article. “If something has a therapeutic action in a human body, this substance can also cause a reaction or an interaction,” she added.

Her article lists out common examples such as an increased risk of significant bleeding associated with garlic, ginkgo, ginger, and saw palmetto supplements; decreased blood sugar as a result of cinnamon, whey protein and others; hormonal effects of dong quai and saw palmetto; and elevated blood pressure caused by hawthorn and green tea.

A study by the American Society of Plastic Surgeons in 2006 showed that many “harmless” supplements could have dangerous side-effects. An article in the February 2006 issue of Plastic and Reconstructive Surgery found approximately 55% of plastic surgery patients (compared to 24% of the general public) took supplements but did not tell their surgeons. “Chondroitin is often used to treat osteoarthritis. People using chondroitin may suffer from bleeding complications during surgery, particularly when used in combination with doctor-prescribed blood-thinning medications,” the piece said. “Ephedra has been known to promote weight loss, increase energy and treat respiratory tract conditions such as asthma and bronchitis. This agent has been banned by the US Food and Drug Administration because it can raise blood pressure, heart rate and metabolic rate, ultimately causing heart attacks, heart arrhythmia, stroke and even death,” the study added.

But there are some like nutritionist Naini Setalvad who maintain that natural is totally safe.
“There are no side-effects to natural supplements. It is all a ploy of the pharmaceutical industry to check the growing popularity of natural herbs and supplements,” she said.

Most Indian patients have their grandmother’s nuska packed in their medicinal chest, and use haldi as a disinfectant or ginger as an antiseptic. Orthopaedic surgeon Dr Sanjeev Agarwala, who heads the department at Hinduja Hospital, said, “We are more comfortable with natural supplements than with proprietary (branded) drugs because of our heritage that is steeped in Ayurveda. But there is little scientific evidence to support this belief.” He offers a scientific reason to doubt the natural-is-safe claim: “Most herbal and natural supplements are alkaloid in nature and could be poisonous unless proven otherwise.”

According to nutritionist Shilpa Joshi, people should always inform their doctors about the supplements they are taking. “We take natural or Ayurvedic stuff thinking these are ghar ka nuska, but if taken with other medications and in high concentrations, it can be potent. If we consult doctors on such issues, the doctor can change the dosages of either his medication or give the right amount of supplements that is needed for the patient concerned.” In others, customise the dosages of herbal supplements and branded drugs.

Commonly used supplements

Ephedra or somlata, which Ayurvedic physicians believe was the source of somras, is widely used to control asthma, heart problems, rheumatism.

Ginkgo biloba, found in Kashmir as Aziz tree, is used to treat brain disorders, enhance memory or control vitiligo (a skin disease).

Saw palmetto is a berry grown in California but widely available in India to control early baldness.

Side-effects if taken in excess

Bleeding and coagulation | Garlic, ginkgo, ginger and saw palmetto are known to increase the risk of bleeding. These supplements should be discontinued two weeks before surgery, including dental surgery.

Blood sugar | Herbs and supplements that have shown to specifically decrease blood sugar are flaxseed (linseed), cinnamon, whey protein and fenugreek (methi). Diabetic patients need to take these under medical advice. Coca and coca may increase blood sugar.

Hormonal effects | Herbs and supplements such as dong quai (Chinese herb used to reduce PMS), red clover, soy and saw palmetto have androgenic as well as antiandrogenic (male hormone) effects and estrogenic as well as antiestrogenic (female hormone) effects and many other hormonal effects.

Blood pressure | There is a risk of hypertension with ephedra, but even green tea and hawthorn (thorn apple) and mistletoe present the same risk.